Ankylosing spondylitis and spontaneous chronic urticaria – two faces of autoimmunity (clinical case)

Doinita Oprea^(1,2,*), Mihaela Minea^(1,3), Madalina Gabriela Iliescu^(1,2,3), Liliana Elena Stanciu^(1,2), Claudia Ileana Mihailov^(2,4)

1)Balnear and Rehabilitation Sanatorium Techirghiol, Romania
2)Faculty of Medicine, "Ovidius" University of Constanta, Romania
3)Doctoral School of Medicine, "Ovidius" University of Constanta, Romania.
4)Spitalul Clinic CF Constanta

Background. Chronic spontaneous urticaria (CSU) is a common pathology with a prevalence of 1-2% in the population. Chronic underlying infection and mental and emotional stress can sometimes precede the onset of CSU and, once established, can exacerbate the symptoms. The most common comorbidities are autoimmune thyroiditis, vitiligo, atopic pathology, chronic inflammation and psychiatric disorders, such as depression and anxiety. Patients with CSU have an increased risk of comorbid autoimmune diseases, with 0.07-0.1% being associated with ankylosing spondylitis (AS).
Methods. We report a clinical case of a 52-year-old patient diagnosed in 2007 with ankylosing spondylitis (AS) axial form, who has been on treatment with Adalimumab, a tumor necrosis factor-alpha (TNF-alpha) inhibitor since 2016, following the regimen outlined in the product’s Summary of Product Characteristics (SmPC). In April 2024, the patient was diagnosed with chronic spontaneous urticaria.
Results. Given the severe and progressive course of CSU, we discontinued the TNF-alpha inhibitor treatment. The patient underwent a 3-month course of antihistamines and corticosteroids, administered both orally and topically, which proved to be clinically ineffective. Ultimately, the dermatologist initiated treatment with a humanized IgG1-type anti-IgE antibody.
Conclusion. The prompt recognition of CSU in the context of autoimmunity and its association with AS has a significant impact on therapeutic management, involving the concurrent or selective use of a tumor necrosis factor (TNF) inhibitor and a humanized IgG-type anti-IgE antibody.

Keywords: Chronic spontaneous urticaria, ankylosing spondylitis, autoimmunity, efficacy and safety

Corresponding author(s): Doinita Oprea, Faculty of Medicine, "Ovidius" University of Constanta, Romania, email:doi_opr@yahoo.com